Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

CPK TOTAL

Facility

$38.00

Service Code	HCPCS 82550
Hospital Charge Code	4300215
Hospital Revenue Code	301
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of NY Commercial	$24.70
Rate for Payer: Aetna of NY Medicare	$17.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.20
Rate for Payer: Cash Price	$28.50
Rate for Payer: CDPHP Medicare	$14.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$22.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$30.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$30.40
Rate for Payer: EmblemHealth Medicaid	$30.40
Rate for Payer: EmblemHealth Medicare	$12.92
Rate for Payer: EmblemHealth Select Care	$22.80
Rate for Payer: Fidelis Medicare	$15.20
Rate for Payer: Galaxy Health Commercial	$24.70
Rate for Payer: Hamaspik Choice Medicare	$15.20
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$24.70
Rate for Payer: Local 1199SEIU Medicare	$17.48
Rate for Payer: MVP Health Care of NY Commercial	$28.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21.39
Rate for Payer: MVP Health Care of NY Medicare	$15.96
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$28.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.70
Rate for Payer: United Healthcare Commercial	$28.50
Rate for Payer: United Healthcare Medicare	$15.20
Rate for Payer: WellCare Medicare	$20.90

CPK TOTAL

Facility

$38.00

Service Code	HCPCS 82550
Hospital Charge Code	4300215
Hospital Revenue Code	301
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$24.70
Rate for Payer: Cash Price	$28.50
Rate for Payer: Galaxy Health Commercial	$24.70

CPR

Facility

$662.00

Service Code	HCPCS 92950
Hospital Charge Code	4600072
Hospital Revenue Code	450
Min. Negotiated Rate	$430.30
Max. Negotiated Rate	$430.30
Rate for Payer: Cash Price	$496.50
Rate for Payer: Galaxy Health Commercial	$430.30

CPR

Facility

$662.00

Service Code	HCPCS 92950
Hospital Charge Code	4600072
Hospital Revenue Code	450
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$304.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$264.80
Rate for Payer: Cash Price	$496.50
Rate for Payer: Cash Price	$496.50
Rate for Payer: Cash Price	$496.50
Rate for Payer: CDPHP Medicare	$244.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$529.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$529.60
Rate for Payer: EmblemHealth Medicaid	$529.60
Rate for Payer: EmblemHealth Medicare	$225.08
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$264.80
Rate for Payer: Galaxy Health Commercial	$430.30
Rate for Payer: Hamaspik Choice Medicare	$264.80
Rate for Payer: Humana Medicare	$264.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$304.52
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$278.04
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$99.30
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$264.80
Rate for Payer: WellCare Medicare	$364.10

C-REACTIVE PROTEIN CRP

Facility

$35.00

Service Code	HCPCS 86140
Hospital Charge Code	4300218
Hospital Revenue Code	300
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna of NY Commercial	$22.75
Rate for Payer: Aetna of NY Medicare	$16.10
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.00
Rate for Payer: Cash Price	$26.25
Rate for Payer: CDPHP Medicare	$12.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$21.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$28.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$28.00
Rate for Payer: EmblemHealth Medicaid	$28.00
Rate for Payer: EmblemHealth Medicare	$11.90
Rate for Payer: EmblemHealth Select Care	$21.00
Rate for Payer: Fidelis Medicare	$14.00
Rate for Payer: Galaxy Health Commercial	$22.75
Rate for Payer: Hamaspik Choice Medicare	$14.00
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.75
Rate for Payer: Local 1199SEIU Medicare	$16.10
Rate for Payer: MVP Health Care of NY Commercial	$26.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.70
Rate for Payer: MVP Health Care of NY Medicare	$14.70
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$26.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.25
Rate for Payer: United Healthcare Commercial	$26.25
Rate for Payer: United Healthcare Medicare	$14.00
Rate for Payer: WellCare Medicare	$19.25

C-REACTIVE PROTEIN CRP

Facility

$35.00

Service Code	HCPCS 86140
Hospital Charge Code	4300218
Hospital Revenue Code	300
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$22.75
Rate for Payer: Cash Price	$26.25
Rate for Payer: Galaxy Health Commercial	$22.75

CREATININE CLEARANCE

Facility

$28.00

Service Code	HCPCS 82575
Hospital Charge Code	4300221
Hospital Revenue Code	301
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$18.20
Rate for Payer: Cash Price	$21.00
Rate for Payer: Galaxy Health Commercial	$18.20

CREATININE CLEARANCE

Facility

$28.00

Service Code	HCPCS 82575
Hospital Charge Code	4300221
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna of NY Commercial	$18.20
Rate for Payer: Aetna of NY Medicare	$12.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.20
Rate for Payer: Cash Price	$21.00
Rate for Payer: CDPHP Medicare	$10.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$16.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$22.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$22.40
Rate for Payer: EmblemHealth Medicaid	$22.40
Rate for Payer: EmblemHealth Medicare	$9.52
Rate for Payer: EmblemHealth Select Care	$16.80
Rate for Payer: Fidelis Medicare	$11.20
Rate for Payer: Galaxy Health Commercial	$18.20
Rate for Payer: Hamaspik Choice Medicare	$11.20
Rate for Payer: Humana Medicare	$11.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$18.20
Rate for Payer: Local 1199SEIU Medicare	$12.88
Rate for Payer: MVP Health Care of NY Commercial	$21.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$15.76
Rate for Payer: MVP Health Care of NY Medicare	$11.76
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$21.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.20
Rate for Payer: United Healthcare Commercial	$21.00
Rate for Payer: United Healthcare Medicare	$11.20
Rate for Payer: WellCare Medicare	$15.40

CREATININE SERUM

Facility

$15.00

Service Code	HCPCS 82565
Hospital Charge Code	4300222
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of NY Commercial	$9.75
Rate for Payer: Aetna of NY Medicare	$6.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: CDPHP Medicare	$5.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.00
Rate for Payer: EmblemHealth Medicaid	$12.00
Rate for Payer: EmblemHealth Medicare	$5.10
Rate for Payer: EmblemHealth Select Care	$9.00
Rate for Payer: Fidelis Medicare	$6.00
Rate for Payer: Galaxy Health Commercial	$9.75
Rate for Payer: Hamaspik Choice Medicare	$6.00
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.75
Rate for Payer: Local 1199SEIU Medicare	$6.90
Rate for Payer: MVP Health Care of NY Commercial	$11.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.45
Rate for Payer: MVP Health Care of NY Medicare	$6.30
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$11.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.25
Rate for Payer: United Healthcare Commercial	$11.25
Rate for Payer: United Healthcare Medicare	$6.00
Rate for Payer: WellCare Medicare	$8.25

CREATININE SERUM

Facility

$15.00

Service Code	HCPCS 82565
Hospital Charge Code	4300222
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Cash Price	$11.25
Rate for Payer: Galaxy Health Commercial	$9.75

CREATININE URINE RANDOM

Facility

$16.00

Service Code	HCPCS 82570
Hospital Charge Code	4300223
Hospital Revenue Code	301
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna of NY Commercial	$10.40
Rate for Payer: Aetna of NY Medicare	$7.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: CDPHP Medicare	$5.92
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.80
Rate for Payer: EmblemHealth Medicaid	$12.80
Rate for Payer: EmblemHealth Medicare	$5.44
Rate for Payer: EmblemHealth Select Care	$9.60
Rate for Payer: Fidelis Medicare	$6.40
Rate for Payer: Galaxy Health Commercial	$10.40
Rate for Payer: Hamaspik Choice Medicare	$6.40
Rate for Payer: Humana Medicare	$6.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.40
Rate for Payer: Local 1199SEIU Medicare	$7.36
Rate for Payer: MVP Health Care of NY Commercial	$12.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.01
Rate for Payer: MVP Health Care of NY Medicare	$6.72
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$12.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.40
Rate for Payer: United Healthcare Commercial	$12.00
Rate for Payer: United Healthcare Medicare	$6.40
Rate for Payer: WellCare Medicare	$8.80

CREATININE URINE RANDOM

Facility

$16.00

Service Code	HCPCS 82570
Hospital Charge Code	4300223
Hospital Revenue Code	301
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Galaxy Health Commercial	$10.40

CREON DR 24,000 UNIT CAPSULE 24000 unit, 100 eaches

Facility

$28.00

Service Code	NDC 32122401
Hospital Charge Code	4401547
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna of NY Commercial	$19.60
Rate for Payer: Aetna of NY Medicare	$12.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.20
Rate for Payer: Cash Price	$21.00
Rate for Payer: CDPHP Medicare	$10.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$22.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$22.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$22.40
Rate for Payer: EmblemHealth Medicaid	$22.40
Rate for Payer: EmblemHealth Medicare	$9.52
Rate for Payer: EmblemHealth Select Care	$20.16
Rate for Payer: Fidelis Medicare	$11.20
Rate for Payer: Galaxy Health Commercial	$18.20
Rate for Payer: Hamaspik Choice Medicare	$11.20
Rate for Payer: Humana Medicare	$11.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$19.60
Rate for Payer: Local 1199SEIU Medicare	$12.88
Rate for Payer: MVP Health Care of NY Commercial	$21.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$15.76
Rate for Payer: MVP Health Care of NY Medicare	$11.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.20
Rate for Payer: United Healthcare Medicare	$11.20
Rate for Payer: WellCare Medicare	$15.40

CREON DR 24,000 UNIT CAPSULE 24000 unit, 100 eaches

Facility

$28.00

Service Code	NDC 32122401
Hospital Charge Code	4401547
Hospital Revenue Code	250
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$18.20
Rate for Payer: Cash Price	$21.00
Rate for Payer: Galaxy Health Commercial	$18.20
Rate for Payer: WellCare Medicare	$15.40

CRESTOR 10 MG

Facility

$6.18

Hospital Charge Code	4401257
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$4.64
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: WellCare Medicare	$3.40

CRESTOR 10 MG

Facility

$6.18

Hospital Charge Code	4401257
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
Rate for Payer: Aetna of NY Medicare	$2.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.47
Rate for Payer: Cash Price	$4.64
Rate for Payer: CDPHP Medicare	$2.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.94
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4.94
Rate for Payer: EmblemHealth Medicaid	$4.94
Rate for Payer: EmblemHealth Medicare	$2.10
Rate for Payer: EmblemHealth Select Care	$4.45
Rate for Payer: Fidelis Medicare	$2.47
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.47
Rate for Payer: Humana Medicare	$2.47
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.33
Rate for Payer: Local 1199SEIU Medicare	$2.84
Rate for Payer: MVP Health Care of NY Commercial	$4.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

CROSSFLOW INTEGRATED CASSETTE TUBING

Facility

$543.84

Hospital Charge Code	4479238
Hospital Revenue Code	270
Min. Negotiated Rate	$353.50
Max. Negotiated Rate	$353.50
Rate for Payer: Cash Price	$407.88
Rate for Payer: Galaxy Health Commercial	$353.50

CROSSFLOW INTEGRATED CASSETTE TUBING

Facility

$543.84

Hospital Charge Code	4479238
Hospital Revenue Code	270
Min. Negotiated Rate	$81.58
Max. Negotiated Rate	$435.07
Rate for Payer: Aetna of NY Commercial	$380.69
Rate for Payer: Aetna of NY Medicare	$250.17
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$217.54
Rate for Payer: Cash Price	$407.88
Rate for Payer: CDPHP Medicare	$201.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$435.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$435.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$435.07
Rate for Payer: EmblemHealth Medicaid	$435.07
Rate for Payer: EmblemHealth Medicare	$184.91
Rate for Payer: EmblemHealth Select Care	$391.56
Rate for Payer: Fidelis Medicare	$217.54
Rate for Payer: Galaxy Health Commercial	$353.50
Rate for Payer: Hamaspik Choice Medicare	$217.54
Rate for Payer: Humana Medicare	$217.54
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$380.69
Rate for Payer: Local 1199SEIU Medicare	$250.17
Rate for Payer: MVP Health Care of NY Commercial	$407.88
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$306.18
Rate for Payer: MVP Health Care of NY Medicare	$228.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$81.58
Rate for Payer: United Healthcare Medicare	$217.54
Rate for Payer: WellCare Medicare	$299.11

CRUTCH ALUM PUSH BTN ADULT

Facility

$33.99

Hospital Charge Code	4471294
Hospital Revenue Code	270
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$22.09
Rate for Payer: Cash Price	$25.49
Rate for Payer: Galaxy Health Commercial	$22.09

CRUTCH ALUM PUSH BTN ADULT

Facility

$33.99

Hospital Charge Code	4471294
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$27.19
Rate for Payer: Aetna of NY Commercial	$23.79
Rate for Payer: Aetna of NY Medicare	$15.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.60
Rate for Payer: Cash Price	$25.49
Rate for Payer: CDPHP Medicare	$12.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$27.19
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$27.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.19
Rate for Payer: EmblemHealth Medicaid	$27.19
Rate for Payer: EmblemHealth Medicare	$11.56
Rate for Payer: EmblemHealth Select Care	$24.47
Rate for Payer: Fidelis Medicare	$13.60
Rate for Payer: Galaxy Health Commercial	$22.09
Rate for Payer: Hamaspik Choice Medicare	$13.60
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23.79
Rate for Payer: Local 1199SEIU Medicare	$15.64
Rate for Payer: MVP Health Care of NY Commercial	$25.49
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.14
Rate for Payer: MVP Health Care of NY Medicare	$14.28
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.10
Rate for Payer: United Healthcare Medicare	$13.60
Rate for Payer: WellCare Medicare	$18.69

CRUTCHES ANY SIZE

Facility

$52.53

Hospital Charge Code	4472197
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$42.02
Rate for Payer: Aetna of NY Commercial	$36.77
Rate for Payer: Aetna of NY Medicare	$24.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$21.01
Rate for Payer: Cash Price	$39.40
Rate for Payer: CDPHP Medicare	$19.44
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$42.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$42.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$42.02
Rate for Payer: EmblemHealth Medicaid	$42.02
Rate for Payer: EmblemHealth Medicare	$17.86
Rate for Payer: EmblemHealth Select Care	$37.82
Rate for Payer: Fidelis Medicare	$21.01
Rate for Payer: Galaxy Health Commercial	$34.14
Rate for Payer: Hamaspik Choice Medicare	$21.01
Rate for Payer: Humana Medicare	$21.01
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$36.77
Rate for Payer: Local 1199SEIU Medicare	$24.16
Rate for Payer: MVP Health Care of NY Commercial	$39.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$29.57
Rate for Payer: MVP Health Care of NY Medicare	$22.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$7.88
Rate for Payer: United Healthcare Medicare	$21.01
Rate for Payer: WellCare Medicare	$28.89

CRUTCHES ANY SIZE

Facility

$52.53

Hospital Charge Code	4472197
Hospital Revenue Code	270
Min. Negotiated Rate	$34.14
Max. Negotiated Rate	$34.14
Rate for Payer: Cash Price	$39.40
Rate for Payer: Galaxy Health Commercial	$34.14

CRUTCHES-S

Facility

$32.96

Hospital Charge Code	4601186
Hospital Revenue Code	270
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$26.37
Rate for Payer: Aetna of NY Commercial	$23.07
Rate for Payer: Aetna of NY Medicare	$15.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.18
Rate for Payer: Cash Price	$24.72
Rate for Payer: CDPHP Medicare	$12.20
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$26.37
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$26.37
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$26.37
Rate for Payer: EmblemHealth Medicaid	$26.37
Rate for Payer: EmblemHealth Medicare	$11.21
Rate for Payer: EmblemHealth Select Care	$23.73
Rate for Payer: Fidelis Medicare	$13.18
Rate for Payer: Galaxy Health Commercial	$21.42
Rate for Payer: Hamaspik Choice Medicare	$13.18
Rate for Payer: Humana Medicare	$13.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23.07
Rate for Payer: Local 1199SEIU Medicare	$15.16
Rate for Payer: MVP Health Care of NY Commercial	$24.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$18.56
Rate for Payer: MVP Health Care of NY Medicare	$13.84
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.94
Rate for Payer: United Healthcare Medicare	$13.18
Rate for Payer: WellCare Medicare	$18.13

CRUTCHES-S

Facility

$32.96

Hospital Charge Code	4601186
Hospital Revenue Code	270
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$24.72
Rate for Payer: Galaxy Health Commercial	$21.42

CSF CELL COUNT

Facility

$17.00

Service Code	HCPCS 89051
Hospital Charge Code	4304872
Hospital Revenue Code	300
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$12.75
Rate for Payer: Galaxy Health Commercial	$11.05

Know your out-of-pocket cost for care.

All Charges